Low-dose prednisone inclusion in a methotrexate-based, tight control strategy for early rheumatoid arthritis: a randomized trial
Annals of Internal Medicine, 03/09/2012Bakker MF et al.
Inclusion of low–dose prednisone in an MTX–based treatment strategy for tight control in early RA improves patient outcomes.
A 2–year, prospective, randomized, placebo–controlled, double–blind, multicenter trial (CAMERA–II [Computer Assisted Management in Early Rheumatoid Arthritis trial–II]).
7 hospitals in the Netherlands.
236 patients with early RA (duration <1 year).
Patients were randomly assigned to an MTX–based, tight control strategy starting with either MTX and prednisone or MTX and placebo.
Methotrexate treatment was tailored to the individual patient at monthly visits on the basis of predefined response criteria aiming for remission.
The primary outcome was radiographic erosive joint damage after 2 years.
Secondary outcomes included response criteria, remission, and the need to add cyclosporine or a biologic agent to the treatment.
Erosive joint damage after 2 years was limited and less in the group receiving MTX and prednisone (n = 117) than in the group receiving MTX and placebo (n = 119).
The MTX and prednisone strategy was also more effective in reducing disease activity and physical disability, achieving sustained remission, and avoiding the addition of cyclosporine or biologic treatment.
Adverse events were similar in both groups, but some occurred less in the MTX and prednisone group.
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